title: Impact of evaluating antibiotic concentrations in abdominal abscesses percutaneously drained.
abstract: BACKGROUND
  Appropriate antibiotic therapy and prompt drainage are essential for optimal results with abdominal abscesses.
  
  
  METHODS
  In this prospective study, 47 abdominal abscesses from 42 patients over 2 years who had percutaneous drainage were evaluated. Antibiotic concentrations were evaluated from the abscess fluid and correlated with clinical and microbiologic cure.
  
  
  RESULTS
  Only 23% of patients had appropriate antibiotic selection with optimal concentrations for the bacteria recovered. Piperacillin/tazobactam, cefepime, and metronidazole provided adequate concentrations in all except the largest abscesses, whereas fluconazole required higher doses in all abscesses. Vancomycin and ciprofloxacin levels were inadequate in most abscesses. With gram-negative aerobes, the use of appropriate antibiotics resulted in a relatively higher incidence of presumed eradication (100% [4 of 4] vs 75% [9 of 12], P = .26). With ≥ 3 organisms identified, clinical failure was significant (58% vs 13%, P = .01).
  
  
  CONCLUSIONS
  For optimal treatment, abdominal abscesses require prompt drainage and properly selected antibiotics at adequate doses. Essential information can be obtained from abscess cultures and their antibiotic concentrations.
authors.affiliation: Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, MI, USA. lhall5@dmc.org
authors.forename: Lisa Hall
authors.initials: LH
authors.lastname: Zimmerman
authors.forename: James G
authors.initials: JG
authors.lastname: Tyburski
authors.forename: Jerry
authors.initials: J
authors.lastname: Glowniak
authors.forename: Rohit
authors.initials: R
authors.lastname: Singla
authors.forename: Todd
authors.initials: T
authors.lastname: Lavery
authors.forename: Michael
authors.initials: M
authors.lastname: Nailor
authors.forename: Jerry
authors.initials: J
authors.lastname: Stassinopoulus
authors.forename: Kaleford
authors.initials: K
authors.lastname: Hong
authors.forename: Surendra
authors.initials: S
authors.lastname: Barshikar
authors.forename: Heather S
authors.initials: HS
authors.lastname: Dolman
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Baylor
authors.forename: Robert F
authors.initials: RF
authors.lastname: Wilson
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage / Q000493:pharmacokinetics; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000493:pharmacokinetics; D005122:Exudates and Transudates / Q000378:metabolism*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000493:pharmacokinetics; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D010878:Piperacillin / Q000008:administration & dosage / Q000493:pharmacokinetics; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D013396:Suction; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D008795:Metronidazole; D000077725:Piperacillin, Tazobactam Drug Combination; D002939:Ciprofloxacin; D014640:Vancomycin; D000077723:Cefepime; D010397:Penicillanic Acid; D015725:Fluconazole; D010878:Piperacillin